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Impact of Arterial Carbon Dioxide and Oxygen Content on Cerebral Autoregulation Monitoring Among Children Supported by ECMO.
Joram, Nicolas; Beqiri, Erta; Pezzato, Stefano; Moscatelli, Andrea; Robba, Chiara; Liet, Jean-Michel; Chenouard, Alexis; Bourgoin, Pierre; Czosnyka, Marek; Léger, Pierre-Louis; Smielewski, Peter.
Afiliação
  • Joram N; Pediatric Intensive Care Unit, University Hospital of Nantes, Nantes, France. nicolas.joram@chu-nantes.fr.
  • Beqiri E; Clinical Investigation Center (CIC) 1413, University Hospital of Nantes, Nantes, France. nicolas.joram@chu-nantes.fr.
  • Pezzato S; INSERM U955-ENVA, University Paris 12, Paris, France. nicolas.joram@chu-nantes.fr.
  • Moscatelli A; Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
  • Robba C; Department of Physiology and Transplantation, Milan University, Milan, Italy.
  • Liet JM; Pediatric Intensive Care Unit, IRCCS Giannina Gaslini Institute, Genoa, Italy.
  • Chenouard A; Pediatric Intensive Care Unit, IRCCS Giannina Gaslini Institute, Genoa, Italy.
  • Bourgoin P; Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
  • Czosnyka M; Policlinico San Martino IRCCS for Oncology and Neuroscience, Genova, Italy.
  • Léger PL; Pediatric Intensive Care Unit, University Hospital of Nantes, Nantes, France.
  • Smielewski P; Clinical Investigation Center (CIC) 1413, University Hospital of Nantes, Nantes, France.
Neurocrit Care ; 35(2): 480-490, 2021 10.
Article em En | MEDLINE | ID: mdl-33686559
BACKGROUND: Cerebral autoregulation (CA) impairment is associated with neurological complications among children supported by extracorporeal membrane oxygenation (ECMO). Severe variations of arterial CO2 (PaCO2) and O2 (PaO2) tension after ECMO onset are common and associate with mortality and poor neurological outcome. The impact of gas exchange on CA among critically ill patients is poorly studied. METHODS: Retrospective analysis of data collected prospectively from 30 children treated with veno-arterial or veno-venous ECMO in the PICU of Nantes University Hospital, France. A correlation coefficient between the variations of regional cerebral oxygen saturation (rSO2) and the variations of mean arterial blood pressure (MAP) was calculated as an index of CA (cerebral oxygenation reactivity index, COx). Cox-MAP plots were investigated allowing determining lower limit of autoregulation (LLA) and upper limit of autoregulation (ULA) limits of autoregulation. Age-based normal blood pressure was used to adjust the MAP, LLA, and ULA data from each patient and then reported as percentage (nMAP, nLLA, and nULA, respectively). RSO2, COx, nMAP, nLLA, and nULA values were averaged over one hour before each arterial blood gas (ABG) sample during ECMO run. RESULTS: Thirty children (median age 4.8 months [Interquartile range (IQR) 0.7-39.1], median weight 5 kg [IQR 4-15]) experiencing 31 ECMO runs were included in the study. Three hundred and ninety ABGs were analyzed. The highest values of COx were observed on day 1 (D1) of ECMO. The relationship between COx and PaCO2 was nonlinear, but COx values tended to be lower in case of hypercapnia compared to normocapnia. During the whole ECMO run, a weak but significant correlation between PaCO2 and nULA was observed (R = 0.432, p = 0.02). On D1 of ECMO, this correlation was stronger (R = 0.85, p = 0.03) and a positive correlation between nLLA and PaCO2 was also found (R = 0.726, p < 0.001). A very weak negative correlation between PaO2 and nULA was observed within the whole ECMO run and on D1 of ECMO (R = -0.07 p = 0.04 and R = -0.135 p = <0.001, respectively). The difference between nULA and nLLA representing the span of the autoregulation plateau was positively correlated with PaCO2 and negatively correlated with PaO2 (R = 0.224, p = 0.01 and R = -0.051, p = 0.004, respectively). CONCLUSIONS: We observed a complex relationship between PaCO2 and CA, influenced by the level of blood pressure. Hypercapnia seems to be globally protective in normotensive or hypertensive condition, while, in case of very low MAP, hypercapnia may disturb CA as it increases LLA. These data add additional arguments for very cautiously lower PaCO2, especially after ECMO start.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Dióxido de Carbono / Oxigenação por Membrana Extracorpórea Tipo de estudo: Observational_studies / Risk_factors_studies Limite: Child / Humans / Infant Idioma: En Ano de publicação: 2021 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Dióxido de Carbono / Oxigenação por Membrana Extracorpórea Tipo de estudo: Observational_studies / Risk_factors_studies Limite: Child / Humans / Infant Idioma: En Ano de publicação: 2021 Tipo de documento: Article